Aug 2012

5 Questions With Abhay R. Vasavada, FRCS

How has cataract surgery changed
since you started practicing?

When I began practice 28 years ago,
extracapsular cataract extraction and IOLs
were just being introduced. Cataract surgery
was not considered to be a subspecialty,
and I was probably the first ophthalmologist
in India to start practicing as a “cataract specialist.”
Fortunately, we have come a long way since those days.

Advances in diagnostic and surgical techniques and
technologies have allowed cataract surgeons to achieve
superior surgical performance and control and to optimize
outcomes for our patients. I remember when operating on
a brunescent or a mature cataract meant several sleepless
nights for me. Today, thanks to refinements in surgical techniques,
a much better control of energy delivery and fluidics,
and adjuncts like ophthalmic viscosurgical devices, we can
offer consistent and predictable outcomes even in challenging
scenarios.

With a renewed understanding of surgically induced
astigmatism came the advent of microincisional cataract
surgery. Microcoaxial phacoemulsification has enabled us
to deliver the same performance through smaller incisions,
but we surgeons have yet to determine the ideal incisional
size that will minimize surgically induced astigmatism without
distorting the wound. Newer IOLs have significantly
improved visual performance. In the future, I hope to offer
customized cataract surgery based on individual needs and
requirements. Substantial research has been done to elucidate
the etiogenesis of cataract and modes to prevent it.
More research, however, is needed on this topic. Research
on posterior capsular opacification has tremendously benefitted
our patients and ourselves. These are exciting times
for cataract surgeons, and I hope for the answers to more
questions in time.

You have dedicated your research to congenital
cataracts in children. What questions do you still
hope to answer?

I would like to uncover the cause of congenital cataracts
and the genetics behind them. Answering these
questions will be the final step in understanding the genesis
of, and therefore possibly preventing, these cataracts.
I also hope to discover if primary IOL implantation is safe
and effective in infants younger than 1 year of age. I hope
that an ongoing clinical trial at our center, the Aphakia
Versus Pseudophakia Trial, will provide meaningful data
about this matter.

Posterior capsular opacification is another enigma. If we
ophthalmologists can find a way to prevent this complication
without harming the eye, it will be a great help to
these children. I want to do away with anterior vitrectomy
while performing cataract surgery on infants and very
young children.

What skills do you try to instill in the fellows you
have trained at the Iladevi Cataract & IOL Center?

I am passionate about passing on skills and wisdom to
my fellows and colleagues. I started a cataract surgical fellowship
program in 1989, and I have trained over 130 ophthalmologists,
including national and international fellows.
The first lesson I instill in all of my fellows is compassion
for patients. The second is an attention to details, for this
skill differentiates good from excellent ophthalmologists.
During cataract surgery, each step is important, so I make
sure my fellows learn surgery in a step-by-step manner and
are supervised at all times. I also try to instill an attitude of
scientific curiosity and a desire to learn. Only by questioning
our current practices and beliefs can we do better for
our patients and ourselves. I therefore encourage all my
fellows to participate in active clinical research.

What motivates you to participate in live demonstrations
of cataract surgery throughout the world?

Doing so gives me an opportunity to show the tips,
tricks, and techniques that I find useful as a surgeon. It is
also a wonderful platform for discussing different perspectives
with the cofaculty and the attendees. Personally, I
find it thrilling to operate live!

What is your ideal vacation?

This is a difficult question to answer. Ideally, I would
choose a quiet place, somewhere close to nature. For the
past few years, my travel for educational purposes has
increased tremendously, and these trips have become working
vacations: educational activities and relaxation time are
mixed in one trip. An “ideal vacation” is becoming a rarity
for me.